Transmastoid extracranial repair of CSF leaks following acoustic neuroma resection

1989 ◽  
Vol 103 (9) ◽  
pp. 842-844 ◽  
Author(s):  
A. K. Robson ◽  
P. M. Clarke ◽  
M. Dilkes ◽  
A. R. Maw
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Management ◽  
Acoustic Neuroma ◽  
Complete Resolution ◽  
Sternomastoid Muscle ◽  
Translabyrinthine Approach ◽  
Suboccipital Craniectomy ◽  
Acoustic Neuromas ◽  
Good Access ◽  
Csf Leaks

AbstractAcoustic neuromas may be resected either by a suboccipital craniectomy or translabyrinthine approach; the latter gives good access without unduly traumatising the brainstem, but can lead to a higher incidence of cerebrospinal fluid (CSF) leaks. The surgical management of these leaks can be difficult; we describe a transmastoid extracranial technique using pedicled sternomastoid muscle that has produced complete resolution of the leak in all cases managed in this way.

Translabyrinthine Approach for Acoustic Neuroma

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 391-396 ◽  
Author(s):  
John Diaz Day ◽  
Douglas A. Chen ◽  
Moises Arriaga
Keyword(s):  
Surgical Treatment ◽  
Acoustic Neuroma ◽  
Cerebellopontine Angle ◽  
Hearing Preservation ◽  
Retrosigmoid Approach ◽  
The Past ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Abstract THE TRANSLABYRINTHINE APPROACH has been popularized during the past 30 years for the surgical treatment of acoustic neuromas. It serves as an alternative to the retrosigmoid approach in patients when hearing preservation is not a primary consideration. Patients with a tumor of any size may be treated by the translabyrinthine approach. The corridor of access to the cerebellopontine angle is shifted anteriorly in contrast to the retrosigmoid approach, resulting in minimized retraction of the cerebellum. Successful use of the approach relies on a number of technical nuances that are outlined in this article.

scholarly journals Surgical management of cerebrospinal fluid rhinorrhea under endoscopic control

2004 ◽  
Vol 62 (3b) ◽  
pp. 827-831 ◽  
Author(s):  
José Alberto Landeiro ◽  
Marlo S. Flores ◽  
Bruno C.R. Lázaro ◽  
Maria Helena Melo
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Management ◽  
Inferior Turbinate ◽  
Saline Injection ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Control ◽  
Free Grafts ◽  
Cranial Approach ◽  
Csf Leaks

The surgical management of cerebrospinal fluid (CSF) rhinorrhea has changed after the introduction of functional endoscopic sinus surgery.The following three cases illustrate the repair of CSF leaks with the use of rigid endoscope. Two patients had the diagnosis and the site confirmed after intrathecal fluoresceine saline injection. The obliteration of the CSF was achieved with fat free, mucoperichondrial or mucoperiostal free grafts taken from middle or inferior turbinate and kept in place by fibrin glue. Primary closure was achieved in all patients. The repair of the CSF rhinorrhea by endonasal endoscopic surgery is safe, effective and is a valid alternative to the cranial approach.

scholarly journals Translabyrinthine Approach for Resection of Large Cystic Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S267-S268
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Extracapsular Dissection ◽  
Cerebellar Retraction

The translabyrinthine approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a translabyrinthine approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the translabyrinthine approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function.The link to the video can be found at: https://youtu.be/zld2cSP8fb8.

scholarly journals Retractorless translabyrinthine approach for resection of a large acoustic neuroma: operative video and technical nuances

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu ◽  
Robert W. Jyung
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Tumor Resection ◽  
Fat Graft ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Large acoustic neuromas, greater than 3 cm, can be technically challenging tumors to remove because of their intimate relationship with the brainstem and surrounding cranial nerves. Successful tumor resection involves functional preservation of the facial nerve and neurovascular structures. The translabyrinthine approach is useful for surgical resection of acoustic neuromas of various sizes in patients with poor preoperative hearing. The presigmoid surgical corridor allows direct exposure of the tumor in the cerebellopontine angle without any fixed cerebellar retraction. Early identification of the facial nerve at the fundus facilitates facial nerve preservation. Large acoustic tumors can be readily removed with a retractorless translabyrinthine approach using dynamic mobilization of the sigmoid sinus. In this operative video atlas report, the authors demonstrate their operative nuances for resection of a large acoustic neuroma via a translabyrinthine approach using a retractorless technique. Facial nerve preservation is achieved by maintaining a plane of dissection between the tumor capsule and the tumor arachnoid so that a layer of arachnoid protects the blood supply to the facial nerve. Multilayered closure is achieved with a fascial sling technique in which an autologous fascia lata graft is sutured to the dural defect to suspend the fat graft in the mastoidectomy defect. We describe the step-by-step technique and illustrate the operative nuances and surgical pearls to safely and efficiently perform the retractorless translabyrinthine approach, tumor resection, facial nerve preservation, and multi-layered reconstruction of the skull base dural defect to prevent postoperative cerebrospinal fluid leakage.The video can be found here: http://youtu.be/ros98UxqVMw.

An Algorithm for the Management of Acoustic Neuromas regarding Age, Hearing, Tumor Size, and Symptoms

1993 ◽  
Vol 108 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Herbert Silverstein ◽  
Seth I. Rosenberg ◽  
John M. Flanzer ◽  
Hayes H. Wanamaker ◽  
Michael D. Seidman
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Pure Tone ◽  
Hearing Preservation ◽  
Subtotal Resection ◽  
Residual Hearing ◽  
Pure Tone Average ◽  
The Past ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

An algorithm has evolved for the management of patients with acoustic neuroma. Decisions as to surgery vs. observation, surgical approach, and whether hearing preservation should be attempted depend on age, patient symptoms, size of the tumor, residual hearing, and degree of facial nerve involvement at the time of surgery. Conservative management is used for patients over 65 years of age. This consists of observation or subtotal resection through a translabyrinthine approach, depending on the absence or presence of brainstem signs or symptoms. In patients under 65 years of age, hearing preservation is attempted through the retrosigmoid approach in tumors 1.5 cm or less if pure-tone average is less than 30 dB and the discrimination score is greater than 70%. The translabyrinthine approach is our preferred approach for tumors of any size when hearing is not serviceable. A near-total excision is performed when the facial nerve cannot be separated from the tumor. The rationale for this algorithm in the management of 130 cases of acoustic neuroma over the past 17 years is presented.

Hearing Preservation Using the Modified Translabyrinthine Approach

1993 ◽  
Vol 108 (6) ◽  
pp. 671-679 ◽  
Author(s):  
John T. McElveen ◽  
Robert H. Wilkins ◽  
David W. Molter ◽  
Andrea C. Erwin ◽  
Robert D. Wolford
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Removal of an acoustic neuroma using the translabyrinthine approach has previously been considered “Incompatible” with hearing preservation. By modifying the approach and preventing the loss of endolymph, we have successfully removed two Intracanallcular acoustic neuromas that originated from the inferior vestibular nerves, and preserved serviceable hearing in the ears operated on. This report represents the preliminary findings using this particular technique in the management of Intracanallcular acoustic neuromas.

scholarly journals Early Diagnosis and Surgical Management of Acoustic Neuroma: Is it Cost Effective?

1989 ◽  
Vol 82 (6) ◽  
pp. 329-332 ◽  
Author(s):  
D A Moffat ◽  
D G Hardy
Keyword(s):  
Early Diagnosis ◽  
Surgical Management ◽  
Acoustic Neuroma ◽  
Surgical Intervention ◽  
Cost Effective ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Acoustic Neuromas ◽  
Acoustic Nerve ◽  
Microsurgical Techniques

Audiological and radiological advances and refinement of microsurgical techniques have facilitated the diagnosis and excision of very small acoustic nerve tumours with a low morbidity and mortality. Is this cost effective? In an attempt to answer this question, an analysis of 66 cases of surgically treated acoustic neuromas is presented. This represents a part of a series of otoneurosurgical procedures carried out at Addenbrooke's Hospital over the last five years. By studying the relative morbidity of early and late surgical intervention in these cases, and by costing the exercise, the justification for early diagnosis and treatment is presented both in financial and human terms.

Translabyrinthine repair for cerebrospinal fluid otorhinorrhea

1982 ◽  
Vol 57 (2) ◽  
pp. 258-261 ◽  
Author(s):  
Stephen G. Harner ◽  
Edward R. Laws
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Eustachian Tube ◽  
Csf Leak ◽  
Content Type ◽  
Translabyrinthine Approach ◽  
Suboccipital Craniectomy ◽  
Acoustic Neurinomas ◽  
Complication Of Surgery ◽  
Fine Print

✓ Cerebrospinal fluid (CSF) otorhinorrhea may occur as a complication of surgery for removal of acoustic neurinomas. The CSF leak usually appears within the first 2 weeks after surgery, and the diagnosis is obvious. The fistulous site is frequently inaccessible and may be difficult to repair by reexploring the suboccipital craniectomy. Successful closure of the fistula is accomplished by obliterating the space between the posterior fossa dura and the eustachian tube orifice with homograft muscle, using a radical translabyrinthine approach.

The Price of Preservation of Hearing in Acoustic Neuroma Surgery

1982 ◽  
Vol 91 (3) ◽  
pp. 240-245 ◽  
Author(s):  
Mirko Tos ◽  
Jens Thomsen
Keyword(s):  
Acoustic Neuroma ◽  
Postoperative Results ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Acoustic Neuroma Surgery ◽  
Facial Function ◽  
Suboccipital Approach

Translabyrinthine surgery for acoustic neuroma was introduced in Denmark in 1976, and the results of the first 100 operations are presented. Two deaths occurred, unrelated to the translabyrinthine surgery. Postoperatively, 75% of the patients had normal facial function, while function was reduced in 15% and abolished in 10%. The series represents 85% of all acoustic neuromas operated in Denmark, with 30 new neuromas being diagnosed each year, derived from a population of 5.1 million. The overall postoperative results are compared with the available results from suboccipital removals of acoustic neuromas, and are clearly in favor of the translabyrinthine approach. It is concluded that centralization of acoustic neuroma surgery is necessary, that all acoustic neuromas regardless of size can be removed by the translabyrinthine approach and that the discussion about the hypothetical preservation of hearing by applying the suboccipital approach is being made without solid grounds. To adduce the theoretical chance of preserving hearing in a very small percentage of patients as an argument in favor of the suboccipital approach appears quite irrelevant, and the price of attempting this with the suboccipital approach is too high.

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